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HISTORY
Bunon (1743): First person to propose that removal of deciduous teeth will achieve a better
alignment of permanent teeth, in his book Essay on diseases of teeth.
Kjellgren (1929): First person to suggest the term serial extraction for this procedure.
Nance (1940): Father of serial extraction philosophy. He presented the technique of
progressive extraction.
Palsson (1956): Proposed that extraction can be done to improve irregular alignment and
crowding of teeth.
Hotz (1970): Suggested the term Guidance of eruption in lieu of serial extraction.
DEFINITION
Serial extraction or Guidance of eruption is defined as a well-planned sequence of tooth
removal during the transition from the primary to the permanent dentition involving timed
extractions of primary, and ultimately, permanent teeth, for the purpose of
relieving crowding and irregularity of teeth
allowing unerupted teeth to guide themselves into improved positions
as an adjunct to comprehensive orthodontic therapy
Note: Serial extraction by itself does not result in an ideal tooth position or closure of
excess space.
RATIONALE
Serial extraction is a positive interceptive orthodontic procedure generally applied where
supporting bone is less than the total tooth material.
Extraction of primary canines eliminates crowding of permanent incisors.
Extraction of 1st premolars before the eruption of permanent canines and 2nd premolars
results in distal eruption of canines and may bring about spontaneous closure of spaces.
The average width of 1st premolar is 7-8 mm; Extraction of premolars creates 14-16 mm of
space in the arch. After serial extraction incisors tend to drift lingually and the posterior teeth
tend to drift mesially to some extent, leading to 2-3 mm of space closure in each quadrant, or
a total of 4-6 mm. Thus the remaining 10 mm is available for resolution of crowding.
Please refer notes on Incisal Liability for better perception of the need for serial
extraction.
IDEAL CONDITIONS FOR SERIAL EXTRACTION
1. A true relatively severe hereditary tooth-size jaw-size discrepancy (perimeter arch
deficiency).
2. A mesial step mixed dentition developing into a Class I permanent relationship.
3. A minimal overjet relationship of incisor teeth.
4. A minimal overbite relationship of incisor teeth.
5. An orthognathic facial pattern, or a face with a slight alveolodental protrusion (Class I
maxillary mandibular alveolodental protrusion).
6. Class II maxillary alveolodental protrusion (serial extraction only in the maxillary arch).
7. No skeletal disproportions.
8. No aberrant muscle activity.
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SERIAL EXTRACTION
R V SUBRAMANYAM
SERIAL EXTRACTION
Fixed or removable lingual arches to minimize mesial migration of permanent 1st molars.
Maxillary transpalatal holding arch (Nance arch), for the same reason as above.
Cervical headgear attached to anterior teeth to achieve Class I buccal interdigitation.
Removable Hawley appliance
To overjet.
To align rotated incisors.
With bite plane to correct deep overbites.
R V SUBRAMANYAM
REFERENCES
1. Graber
Orthodontics-Principles and Practice 3/e
W.B.Saunders, 1988: pgs 709-748.
2. Graber and Vanarsdall,Jr.
Principles and Practice of Orthodontics 2/e
Mosby Year Book, 1994: pgs 309-314
3. Jacob S.G.
Re-assessment of Serial extraction
Australian Orthodontic Journal 1987: 10(2): 90-97.
4. Proffit
Contemporary Orthodontics
C.V.Mosby, 1986: pgs 187-188; 337-341.
5. Tweed C.H.
Clinical Orthodontics Vol.1
C.V.Mosby, 1966: pgs 261-264.